The route to mental health care for children in rural communities is complex, dynamic, and nonlinear, with multiple roadblocks. Although faced with multiple roadblocks, there are also several factors that help minimize these barriers.
Synopsis
Three sequences of the Early Devonian Rhynie Cherts Unit intersected by cored boreholes at the Rhynie SSSI (Site of Special Scientific Interest) are compared on the basis of both lithology and plant content. It is shown that over the 45–65 m distance covered by the boreholes general correlation can be made of the chert-bearing unit, and also sandstone and shale units. General thicknesses of units are similar in the three boreholes. However, there is no bed-to-bed correlation of the cherts or other lithologies, neither is there a correlation in the sequences of plants recorded. It is considered that the sequence was deposited in the distal regions of sinter deposition on a low-angle outwash apron from a hot spring, where the water table was close to the surface, and water was frequently ponded. Overbank flooding from a northward-flowing river system periodically inundated the outwash apron, depositing sand and mud and interrupting sinter deposition. On the basis of plant occurrence in the chert beds intersected in the boreholes it is estimated that on average 15% of the area was bare ground, 30% covered with plant litter, and 55% with growing plants. Similar environments are seen today on the distal marshy areas of outwash aprons from hot springs in Yellowstone National Park, USA.
OBJECTIVES: For decades, infants with Duarte galactosemia (DG) have been identified by newborn screening (NBS), but whether they should be treated with dietary restrictions of galactose has remained unknown. To clarify, we conducted a study of dietary and developmental outcomes in 206 children with DG (case patients) and 144 controls, all of whom were 6 to 12 years old.
METHODS:We recruited case patients from states where they were identified by NBS; unaffected siblings served as controls. Diet in infancy was ascertained by retrospective parent surveys; developmental outcomes were assessed in 5 domains, yielding 73 outcome measures for each child. We divided subjects randomly into independent discovery (n = 87) and validation (n = 263) sets. We tested the discovery set to order the 73 outcome measures by ascending P values and tested the 10 outcomes with the lowest P values for possible association with DG in the validation set. We also tested these same 10 outcomes for possible association with milk exposure in infancy among case patients in the validation set.
RESULTS:None of the 73 outcomes tested in the discovery set revealed significant association with DG, and none of the 10 outcomes tested in the validation set revealed either significant association with DG or significant association with milk exposure among children with DG.
CONCLUSIONS:Through our results, we demonstrated that there were no significant differences in outcomes tested between case patients and controls or among case patients as a function of milk exposure in infancy. In this study, we provide a long-needed foundation of knowledge for health care providers, families, and NBS professionals seeking to make evidence-based decisions about DG.
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